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The article offers information on medicines use evaluation guidelines. Topics include Australia's National Medicines Policy defines quality use of medicines (QUM) as ‘selecting management options wisely; a Medicines Use Evaluation (MUE) activity estimating the extent of the appropriate use of medicines; and the objective of MUE Guideline to provide pharmacists with a process to follow in order to implement an MUE within a healthcare organisation.

Off‐label or unlicensed medicines use is extremely common in obstetric and paediatric clinical practice and necessitates greater emphasis on the underlying evidence of a medicines safety or efficacy. This creates significant challenges for pharmacists relating to the supply and use of medicines in this setting. Understanding how and why unlicensed or off‐label medicine use occurs, together with the underlying evidence base, is critical for supporting the quality use of medicines. Addressing issues surrounding unlicensed or off‐label medicine use in a collaborative manner with prescribers and patients can help reduce unnecessary patient concern, possible non‐adherence and risk of suboptimal treatment outcomes. This review summarises current evidence and challenges surrounding off‐label and unlicensed medicine use in the obstetric and paediatric clinical setting from the perspective of key stakeholders. It aims to support pharmacists in their evaluation of the appropriateness of off‐label and unlicensed medicine use, and provide strategies to help manage these challenging medicines management decisions. [ABSTRACT FROM AUTHOR]

Background: Bacterial and viral meningitis are two life‐threatening diseases that pose a socioeconomic burden on many developing countries such as Egypt. Inappropriate management is the main factor contributing to this burden. Aim: Assess the appropriateness of management of bacterial and viral meningitis in accordance with the Infectious Diseases Society of America guidelines and to evaluate the drugs used. Methods: A prospective observational audit study was conducted in a teaching hospital in Egypt to evaluate the appropriateness of meningitis management as part of implementing a proposed institutional antibiotic stewardship program. Fifty‐eight patients met the inclusion criteria. A threshold between 90 and 100% was considered to measure the appropriateness as according to the World Health Organization drug use evaluation guidelines. Results: Viral meningitis affected more than 60% of patients. The empirical regimen consisted primarily of penicillin, ceftriaxone and dexamethasone. The mean duration of the first antimicrobial and antiviral doses were 1.55h and 19–22h respectively. Non‐compliance with standard practice guidelines due to wrong regimen selection was detected in more than 60% of patients. Fewer than 10% of patients received the correct dexamethasone regimen and fewer than 20% of patients had a follow‐up lumbar puncture. The mean length of stay was 9–12 days. Non‐compliance with guidelines resulted in extra charges for more than 70% of patients. Conclusions: Overall compliance with standard practice guidelines was below the proposed thresholds and misuse of drugs, especially antibiotics, was obvious. Institutional antimicrobial stewardship programs are essential to improve the quality of care and to limit medication misuse. [ABSTRACT FROM AUTHOR]

Background Quality use of medicines ( QUM) has been identified as a priority in Sri Lanka. Aim To identify opportunities to optimise QUM, and evaluate medication appropriateness and medication information exchanged with patients and carers on discharge in a Sri Lankan tertiary care hospital. Methods An observational, prospective, cohort study of patients systematically sampled from two medical wards. A research pharmacist determined their pre-admission medication regimen via interview at time of discharge. Issues of poor adherence and discrepancies between the pre- and post-admission medication regimens were recorded. Drug-related problems were categorised into opportunities to optimise drug therapy. The appropriateness of discharge medications was evaluated using a validated tool. The patient or carer was interviewed after discharge regarding the quality of medicine information exchanged in hospital. Results The 578 recruited patients were taking 1756 medications prior to admission, and 657 (37.4%) of these medications were not continued during admission. Opportunities to optimise drug therapy were identified on 1496 occasions during admission (median, 2.0 opportunities/patient), 215 opportunities, (14.4%) were resolved spontaneously by the medical team prior to discharge. The median score for appropriateness of medications on discharge was 1.5 per patient (interquartile range, 0.0-3.5). Of 427 patients surveyed after discharge, 52% recalled being asked about their medications on admission to hospital, 75% about previous adverse medication reactions and 39% recalled being informed about changes to their medications on discharge. Conclusion Significant opportunities exist for pharmacists to enhance quality use of medicines for patients in the current hospital-based healthcare system in Sri Lanka. [ABSTRACT FROM AUTHOR]

Background: The emergence of antimicrobial resistance reinforces the need for antimicrobial stewardship to promote the appropriate and judicious use of antimicrobials. Aim: To quantify restricted antimicrobial use among intensive care unit (ICU) discharges to general wards, and to review appropriateness of antimicrobial use. Method: A prospective clinical audit was conducted over a 2- week period. Medical records for ICU discharges were reviewed, with relevant data extracted (patient characteristics, antimicrobial therapy prescribed, treatment instructions). Appropriateness of restricted antimicrobials used was gauged in accordance with hospital policies and the Therapeutic Guidelines: Antibiotic. Results: 98 patients were discharged from the ICU - 74 (76%) discharged to general wards were on antimicrobials, 15 discharged to general wards were not on antimicrobials and 9 discharged out of the hospital. Of these 74 patients, 31 (42%) were prescribed a total of 57 restricted antimicrobials; only 11 of these 31 (36%) patients had documented approval (from microbiology/infectious diseases teams) for use of restricted antimicrobials. 46 restricted antimicrobials (n = 57; 81%) were deemed clinically appropriate and the remaining 11 were prescribed outside guideline-recommended indications. Conclusion: While most restricted antimicrobials were prescribed according to national guidelines, in only one-third of patients were the restricted antimicrobials 'approved' for use according to hospital policies. Better clinical documentation on treatment plans and review processes for restricted antimicrobial use is needed during the transition from ICU to general wards. INSET: Antimicrobials restricted by the hospital formulary. [ABSTRACT FROM AUTHOR]

Aim: To investigate complementary and alternative medicines (CAM) knowledge and use in patients on warfarin and matched controls, and the association between CAM use and adverse events (bleeding or clotting). Method: A retrospective cohort study was undertaken in the emergency department of a Melbourne hospital. Patients in the warfarin and control groups were those taking/not taking warfarin, respectively (groups matched for age and gender). An investigator-administered questionnaire was used to collect data on CAM knowledge and use, and bleeding/clotting events during the previous 6 months. The international normalised ratio (INR) data during the previous 6 months were obtained from medical and pathology records. Results: 246 warfarin and 246 control group patients were enrolled. Approximately 50% in each group indicated that they knew of the potential for CAM-drug interactions. Only 60 (24%) patients in the warfarin group reported having been advised about CAM use. Compared to controls, a similar proportion of warfarin patients reported CAM use (29% vs 37%; p = 0.07) and significantly fewer used a CAM known to interact with warfarin ('interacting CAM') (11% vs 19%; p = 0.03). In the warfarin group, CAM users and non-users reported a similar number of events below and above their therapeutic INR range and when the INR exceeded 5. CAM users in the warfarin group tended to have more abnormal bleeding events (42% vs 30%; p = 0.06) but a similar number of clotting events (9% vs 10%; p = 0.8) than CAM non-users. Warfarin patients who used 'interacting CAM' had significantly more clotting events than those who used CAM not known to interact with warfarin (18% vs 2%; p = 0.02). Conclusion: CAM knowledge in people on warfarin was poor. 'Interacting CAM' used concomitantly with warfarin may be associated with increased rates of clotting events. [ABSTRACT FROM AUTHOR]

Background: Gentamicin, an aminoglycoside antibiotic, is used to treat gram-negative bacterial infections. In the current Therapeutic Guidelines: Antibiotic, the recommendations for gentamicin have changed, i.e. the initial dose for empirical treatment, subsequent dose calculations and maximum duration of therapy. Aim: To investigate the pattern of gentamicin utilisation and adherence to local gentamicin dosing guidelines. Method: A cross-sectional audit was conducted of available medication charts for inpatients (n = 51) administered gentamicin at a Sydney hospital over a 2 month period. For comparison, patients were stratified according to age into younger (18 to 59 years) or older (≥ 60 years) groups. Results: Of the 51 patients evaluated, only 11 (8 younger, 3 older) had their weight recorded and they received significantly lower gentamicin doses than the recommended dose based on their age and weight. 11 patients received multiple doses of gentamicin with an average of 2.6 (range 2 to 4) days of therapy. The most common dose was gentamicin 240 mg. Conclusion: There was significant under-dosing of gentamicin in patients of all ages who had their weight recorded. Future studies are needed to investigate the impact of gentamicin underdosing on clinical outcomes. [ABSTRACT FROM AUTHOR]